Boron neutron capture therapy (BNCT) is a new cancer treatment modality that is based on a nuclear reaction occurring between boron atoms concentrates within a tumor and a neutron beam. Since the alpha particles and Li (lithium) nuclei generated by the reaction of 10B (n, α) 7Li, have a short range (less than the diameter of a cell), BNCT can selectively destroy tumor cells in which this reaction occurs without serious damage to the surrounding normal cells. BNCT for unresectable locally advanced and/or recurrent head and neck cancers using an accelerator-based BNCT system was approved by the Japanese government for coverage by the national health insurance program in June 2020. Entire tumors could be expected to be irradiated with at least 20 Gy-Eq. (D80 >20 Gy-Eq, calculated based on a tumor/blood boron concentration ratio of 2.5). This treatment is contraindicated in patients with a high risk of carotid artery rupture and infectious meningitis. We have treated 150 unresectable head and neck cancer cases who met the entry criteria between June 2020 and March 2023. We propose to investigate the short- and long-term outcomes of BNCT and establish appropriate indications for this treatment in patients with recurrent/unresectable head and neck cancer.
We performed a retrospective analysis of the data of patients who underwent the initial operation for a benign parotid tumor in our department between September 1999 and March 2023. Data of a total of 1228 patients were analyzed. The most commonly diagnosed tumor was pleomorphic adenoma (764 patients), followed by Warthin tumor (257 patients). In regard to the tumor localization, superficial lobe tumors accounted for 56.7% of all tumors, deep lobe tumors for 19.6% of all tumors, and lower pole tumors for 23.7% of all tumors. Fine-needle aspiration cytology and frozen-section histopathological examination were used to identify the tumor histopathology. The overall rate of postoperative facial nerve palsy was 19%. A multivariate analysis was performed, which identified large-diameter tumors and deep-lobe tumors as the most important predictors of facial palsy. The postoperative facial palsy improved within 12 months of surgery in all cases, and there were no cases of permanent facial palsy. It is important to explain the risks of the postoperative complications to the patients so as to obtain appropriate informed consent from them for surgery.
We retrospectively analyzed the treatment results in 543 oral cancer patients who were admitted to our department between September 1999 and March 2023. The tongue was the most common primary subsite, followed by the gingiva and oral floor. Among the total of 543 cases of oral cancer, there were 132 clinical node-positive cases (24%). The overall 5-year disease-specific survival (DSS) rate was 71.8%, and the 5-year DSS rates in the stage I, II, III, and IV oral cancer cases were 91.5%, 81.2%, 62.1%, and 48.5% respectively. The 5-year DSS rates in the stage I, II, III, and IV tongue cancer cases were 91.4%, 80.6%, 59.5%, and 44.9%, respectively. The new N classification was more reliably associated with the survival as compared with previous N classifications in the tongue carcinoma cases. Among the 184 cases with T2 oral cancer, 77 (42%) were node-positive. An advanced T stage and a positive neck nodal status were significantly associated with poorer 5-year DSS rates.
External auditory exostoses, also referred to as "surfer's ears," primarily occur in cold-water surfers, and are associated with long-term exposure to cold water. There are few reports of external auditory exostoses developing in patients without any history of aquatic activities.
We conducted this study to evaluate the outcomes of patients with squamous cell carcinoma of the maxillary sinus treated primarily in our department. The subjects included 17 cases of squamous cell carcinoma without distant metastasis out of the 29 cases of malignant maxillary sinus tumors treated at our hospital between January 2010 and March 2022. We examined the patient characteristics, the TNM classification of the tumors, the clinical stage and treatment adopted, the survival rate, using Kaplan-Meier analysis, the time to recurrence, and the results of histopathological evaluation after concurrent chemoradiotherapy with intra-arterial cisplatin (RADPLAT) or intravenous cisplatin (CCRT).
Tumors in the pterygopalatine fossa (PPF) are rare, and the most commonly encountered ones are benign neurogenic tumors, such as schwannomas. We report a rare case of schwannoma arising from the extracranial trigeminal nerve (the greater palatine nerve) in the left PPF. The endoscopic medial maxillectomy (EMM) has been used as an endoscopic surgical approach for tumors in the maxillary sinus. However, this procedure sacrifices the inferior turbinate and nasolacrimal duct. Recently, an endoscopic modified medial maxillectomy (EMMM) approach was newly developed to preserve the inferior turbinate and nasolacrimal duct. We applied the EMMM approach for resection of the schwannoma in the PPR. Preoperative transcatheter embolization of the left sphenopalatine artery and an intraoperative CT-guided navigation system were useful for safe and complete tumor resection. Besides postoperative hypoesthesia around his left hard palate, the patient developed no other complications. No local recurrence has been observed until now, one-year after the surgery. The EMMM approach using a CT-guided navigation system is useful for surgical resection of benign tumors of the PPF.
Invasive fungal rhinosinusitis is a disease that tends to occur more frequently in immunosuppressed patients. Herein, we present a case of chronic invasive fungal rhinosinusitis that developed after chemoradiotherapy (CRT) for frontal sinus cancer.
We retrospectively reviewed the data of 190 adults (206 ears) with acquired cholesteatoma who had undergone tympanoplasty at our department between July 2010 and December 2021. The cholesteatoma stages, surgical strategies adopted, recurrence rate, and hearing improvement success rate were analyzed. The extent of cholesteatoma was classified into stages according to the Classification and Staging of cholesteatoma proposed by the Japan Otological Society in 2010. Stage II was the most common in both patients with pars flaccida cholesteatoma and pars tensa cholesteatoma. A canal wall-down mastoidectomy with canal reconstruction using auricular cartilage was performed for ears with stage II/III disease. Staged tympanoplasty was selected for 22.0% of patients with pars flaccida cholesteatoma and 9.1% of patients with pars tensa cholesteatoma. Residual cholesteatoma was observed in 30.0% of patients with pars flaccida cholesteatoma and 50.0% of patients with pars tensa cholesteatoma treated by staged tympanoplasty at the second operation. Three patients (1.6%) with pars flaccida cholesteatoma developed recurrence; all of them were diagnosed as having retraction cholesteatoma. One patient (4.5%) with pars tensa cholesteatoma had a residual cholesteatoma. The hearing improvement success rate was 75.1% in patients with pars flaccida cholesteatoma and 71.4% in patients with pars tensa cholesteatoma. These results indicate the usefulness of canal wall-down mastoidectomy with canal reconstruction using auricular cartilage for minimizing the risk of residual cholesteatoma and retraction cholesteatoma, without compromising on hearing.
The cribriform-morular variant is a rare type of thyroid papillary carcinoma that primarily affects young women under the age of 30 years. This type of cancer accounts for less than 0.5% of all cases of thyroid papillary carcinoma. It could show sporadic or familial occurrence, and familial cases often exhibit APC gene mutations and are linked to familial polyposis coli.
We conducted a retrospective study of 90 cases of laryngeal cancer treated at our department between 2012 and 2021: the patients included 59 cases with the glottic type of cancer (stage I: 39 cases; stage II: 13 cases; stage III: 6 cases; stage IV: 1 case), 28 cases with the supraglottic type of cancer (stage I: 4 cases; stage II: 4 cases; stage III: 4 cases; stage IV: 16 cases), and 3 cases with the subglottic type of cancer (stage II: 1 case; stage IV: 2 cases). The 5-year overall survival rate was 90.2% in the patients with stage I–II disease (61 cases) and 61.3% in the patients with stage III–IV disease (29 cases). In the patients with stage III–IV disease, the poor prognostic factors were: serum albumin level less than 3.6 g/dL at initial diagnosis, neutrophil-to-lymphocyte ratio greater than 3.4, and body mass index less than 20.
We retrospectively analyzed the data of 9 patients with bilateral vocal cord fixation who underwent Ejnell's operation for laterofixation of the vocal folds at our department between January 2012 and December 2021. The bilateral vocal cord fixation was caused by cardiovascular surgery in 3 cases, total thyroidectomy in 2 cases, long-term tracheal intubation in 2 cases, thymectomy in 1 case, and radiotherapy for laryngeal cancer in 1 case. We used a 2-0 nylon suture for laterofixation of the vocal folds; two sutures were used in 5 patients, and one suture in 4 patients. In all the patients, tracheotomy was performed prior to Ejnell's operation to prevent dyspnea. The tracheostoma could be closed in 8 of the 9 patients (89%) after Ejnell's operation. In the remaining 1 patient, the tracheostoma could not be closed, because the patient developed pyogenic spondylodiscitis and became bedridden after the operation. Repeat operation was needed in 3 patients because of recurrence of the glottal stenosis. During the repeat operation, we confirmed the disruption of the nylon thread in all 3 patients. We used silicon spacers to fix the nylon thread in 7 of the 9 patients, and the remaining 2 patients needed repeat Ejnell's operation. Use of a silicon spacer during Ejnell's operation may be of value to minimize the risk of repeat operation.
Sinonasal organized hematomas are hemorrhagic and non-neoplastic lesions, but have locally aggressive characteristics, with the ability to destroy the surrounding bone tissue. These clinical characteristics often lead to these lesions being misdiagnosed as malignancy. Organized hematomas often occur in the maxillary sinus, but the same lesions in the sphenoid sinus are extremely rare. Organized hematomas in the sphenoid sinus are often accompanied by bone destruction of the internal carotid artery wall and cranial base, which may lead to cranial base injury and massive bleeding.
Japanese cedar pollinosis (JCP) is one of the most common diseases in Japan. The prevalence of JCP in Japan was 38.8% in 2019, and approximately 70% of patients with JCP also have Japanese cypress pollinosis. Avoiding exposure to pollen is important for managing the symptoms of pollinosis. We examined Japanese cedar pollen and Japanese cypress pollen dispersals from 1995 to 2023 in Otsu City, Shiga, Japan. Large amounts of pollen dispersal were observed every other year. High average temperatures and long hours of sunshine in the month of July of the previous year were associated with a large amount of pollen dispersal. Cedar pollen dispersal began in early February and ended in the middle of April, while cypress pollen dispersal began in late March and ended in early May. The duration of cedar pollen dispersal was longer than that of cypress pollen dispersal. The amount of pollen dispersal is affected by many factors, including the climate and the age of trees in Japan.
We conducted this retrospective study to investigate the treatment outcomes of 107 patients with hypopharyngeal cancer who received their primary treatment at the Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science Hospital, between January 2010 and March 2022. The 5-year overall survival (OS) and disease-specific survival (DSS) rates were 57.1% and 72.5%, respectively. The 5-year OS rates in patients with stage 0, I, II, III, IVA and IVB disease were 100%, 76.9%, 27.8%, 57.1%, 42.1%, and 40.0%, respectively. The 5-year DSS rates in patients with stage 0, I, II, III, IVA and IVB disease were 100%, 92.9%, 83.3%, 85.7%, 55.7%, and 40.0%, respectively. Then, the treatment outcomes of the patients with early-stage cancer (Stage I–II) were examined in 19 patients treated by transoral surgery and 11 patients treated by radiation therapy. The 5-year OS rates and 5-year DSS rates in the transoral surgery group and radiation therapy group were 77.1% and 72.9%, and 90.9% and 87.5%, respectively. The 5-year local control rates (LCRs) in the transoral surgery group and radiation therapy group were 27.2% and 63.5%, respectively, being lower in the transoral surgery group than that in the radiation therapy group. The rate of positive resection margins in the transoral surgery group was 21.9% in cases with Tis-T2 disease, but positive resection margins recurred in only 28.6% of cases. In the transoral surgery group, even some cases with negative resection margins developed local recurrence. With the provision of appropriate treatment after local recurrence, the 5-year OS and 5-year DSS rates in the transoral surgery group were comparable to those in the radiation therapy group. Appropriate evaluation of the resection margins in these patients during transoral surgery is important and the our method of evaluation needs to be improved.
Transoral surgery is a minimally invasive treatment procedure for superficial laryngo-pharyngeal cancer. We retrospectively evaluated the data of 42 patients with superficial laryngo-pharyngeal cancer who underwent transoral surgery at our department between January 2012 and December 2021. We performed 61 transoral surgeries, including transoral videolaryngoscopic surgery (TOVS) (47 cases) and endoscopic laryngopharyngeal surgery (ELPS) (14 cases) in 42 patients with hypopharyngeal cancer (46 cases), oropharyngeal cancer (8 cases), supraglottic cancer (5 cases), hypopharyngeal and esophageal cancer (1 case), and pharyngeal cancer after laryngectomy (1 case). In most of the cases (50 cases, 82%), the diagnosis was made by upper gastrointestinal endoscopy. The pathological T stage was Tis, T1, and T2 in 31 cases, 26 cases, and 4 cases respectively, and 11 patients developed metachronous multiple laryngo-pharyngeal cancers. Simultaneous double cancer was found in 29 patients; 21 patients (50%) had esophageal cancer and 8 patients (19%) had head and neck cancer. Locoregional recurrence occurred in 7 (16.7%) patients. Three patients developed aspiration pneumonia and 2 patients developed pharyngeal stenosis after surgery. Transoral surgery is a useful and developing procedure for superficial laryngo-pharyngeal cancer and should be applied in carefully selected cases.
We retrospectively evaluated the data of 10 patients (10 ears) with congenital aural stenosis who had undergone meatoplasty and tympanoplasty at our department between November 2005 and December 2019. The symptoms, presence/absence of cholesteatoma, type of middle ear malformations, surgical strategies, and hearing improvement rate were analyzed. Hearing loss was the most common symptom. Eight patients had external auditory canal cholesteatoma. Middle ear malformations were observed in 8 patients; all 8 patients had ossicular anomalies and 2 patients had facial nerve displacement. A canal wall-down mastoidectomy with canal reconstruction using auricular cartilage was performed for ears in which the cholesteatoma invaded the middle ear cavity. Ossicular reconstruction could not be performed in 1 ear because of displacement of the facial nerve and bony closure of the oval window. The overall hearing improvement rate was 75.0%. The success rate in patients without cholesteatoma was 100% and in patients with cholesteatoma was 66.7%. No recurrence of aural stenosis has been noted in any cases after the surgery. We should evaluate middle ear anomalies carefully to avoid complications and achieve hearing improvement in patients with congenital aural stenosis.
